State-of-the-art immunosuppression protocols for pediatric renal transplant recipients
Immunosuppressive protocols used in pediatric kidney transplantation have changed substantially within the last decade. Many transplant centers now focus on the use of tacrolimus and mycophenolate mofetil in combination with early steroid withdrawal, frequently combined with antibody induction therapy. However, this approach is mainly based on treatment efficacy and—compared to other immunosuppressive regimens used in this context—leads to higher rates of viral infections in patients. In this review I assess data from prospective, interventional trials of immunosuppressive therapy in pediatric kidney transplantation. However, since there is a paucity of randomized controlled trials, I also describe the results of studies with weaker designs. The advantages and disadvantages of different immunosuppressive strategies are discussed. Within this framework I suggest ideas for individualized immunosuppressive regimens based on different stratificators that could effect a change from a ‘one size fits all’ to a tailored approach for initial and maintenance immunosuppressive therapy after renal transplantation in the pediatric setting.
KeywordsPediatric transplantation Immunosuppressive therapy Viral infections Rejections Evidence Graft survival
Compliance with ethical standards
Conflicts of interest
Lars Pape has received speaker’s honoraria and travel grants from Novartis Pharmaceuticals and travel grants from Astellas and Sanofi Aventis.
This article does not contain any studies with human participants performed by any of the authors.
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